Adjusting insulin usage and following other precautions

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Exercising when you have T1DM requires a lot more careful thought than exercising when you have type 2 diabetes (T2DM). The reason is, of course, that in T2DM you have insulin in your body that can rise and fall according to the needs of your cells, especially your muscles. In T1DM, however, the only insulin you have is what you take by injection or by inhalation. There are a number of things you must consider when exercising with T1DM:

HBEft i Where you inject the insulin: Insulin taken in the thigh just before a run is absorbed much more quickly than if it were injected in the stomach, for example. Avoid the thigh just before exercise so that you don't become hypoglycemic early in the exercise.

i How much insulin you take: There has to be some insulin in your body for your muscle cells to take up glucose, but if there's too much, you may become hypoglycemic during the exercise and be unable to continue. If there's too little insulin in your system, your muscles may not get enough glucose, and you'll rapidly become fatigued.

i When you take the insulin in relation to the time of the exercise and the time of the last meal: You can usually begin exercising starting one hour after taking rapid-acting, pre-meal insulin.

i The type of insulin you take: If you take short-acting insulin called regular insulin, it doesn't lower the blood glucose as much or as rapidly as rapid-acting insulin called Apidra, Humalog, or Novolog (see Chapter 10). For this reason, you may want to use regular insulin before strenuous exercise rather than the rapid-acting form.

Make sure your child with T1DM (or you) follows these additional precautions when he (or you) actually exercises:

i Wears a bracelet or necklace identifying himself as a person with T1DM

i Checks his blood glucose frequently (every hour) if the exercise lasts more than two hours i Chooses proper socks and shoes i Drinks plenty of water as he feels thirsty i Has a source of rapid-acting glucose available for hypoglycemia i Exercises with a friend

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